Common use of Special Enrollment Period Clause in Contracts

Special Enrollment Period. An Eligible Person and/or Dependent may also be able to enroll during a special enrollment period, as determined by the Maryland Health Benefit Exchange. Except as otherwise specified below, an individual not currently enrolled in a Qualified Health Plan may enroll in any Qualified Health Plan. An individual currently enrolled in a Qualified Health Plan may enroll with his or her dependents in another Qualified Health Plan within the same level of coverage or one metal level higher or lower, if no such Qualified Health Plan is available. A non-covered dependent of an individual currently enrolled in a Qualified Health Plan may be added to the individual’s current Qualified Health Plan or may enroll in any separate Qualified Health Plan. If our business rules for the current Qualified Health Plan do not allow for the dependent(s) to be enrolled in the same Qualified Health Plan, we must allow the enrolled individual and the non- covered dependent(s) to enroll in a different Qualified Health Plan within the same metal level or, if no such Qualified Health Plan is available, one metal level higher or lower. An individual who is not an enrollee and has one or more dependents who are enrollees who do not also qualify for a special enrollment period may enroll in the dependent’s current Qualified Health Plan or may enroll in any separate Qualified Health Plan. If our business rules do not allow for the qualified individual to enroll in the dependent’s current Qualified Health Plan, we must allow the individual to enroll with the dependent(s) in another Qualified Health Plan within the same metal level or one metal level higher or lower if no such Qualified Health Plan is available. For the purpose of this provision, a “qualified individual” is an individual who has been determined eligible to enroll in a Qualified Health Plan through the Maryland Health Benefit Exchange. The Maryland Health Benefit Exchange will allow qualified individuals or Dependents to enroll in or change from one Qualified Health Plan to another as a result of the following triggering events: • Loss of minimum essential coverage. Loss of minimum essential coverage does not include loss due to: ▪ Failure to pay Premiums on a timely basis, including COBRA premium prior to the expiration of COBRA coverage, except for circumstances in which an employer completely ceases its contributions to COBRA continuation coverage or government subsidies of COBRA continuation coverage completely cease; ▪ Situations allowing for rescission of coverage (the individual performs an act, practice, or omission that constitutes fraud, or the individual makes an intentional misrepresentation of material fact); or

Special Enrollment Period. An Eligible Person and/or Dependent may also be able to enroll during a special enrollment period, as determined by the Maryland Health Benefit Exchange. Except as otherwise specified below, an individual not currently enrolled in a Qualified Health Plan may enroll in any Qualified Health Plan. An individual currently enrolled in a Qualified Health Plan may enroll with his or her dependents in another Qualified Health Plan within the same level of coverage or one metal level higher or lower, if no such Qualified Health Plan is available. A non-covered dependent of an individual currently enrolled in a Qualified Health Plan may be added to the individual’s current Qualified Health Plan or may enroll in any separate Qualified Health Plan. If our business rules for the current Qualified Health Plan do not allow for the dependent(s) to be enrolled in the same Qualified Health Plan, we must allow the enrolled individual and the non- covered dependent(s) to enroll in a different Qualified Health Plan within the same metal level or, if no such Qualified Health Plan is available, one metal level higher or lower. An individual who is not an enrollee and has one or more dependents who are enrollees who do not also qualify for a special enrollment period may enroll in the dependent’s current Qualified Health Plan or may enroll in any separate Qualified Health Plan. If our business rules do not allow for the qualified individual to enroll in the dependent’s current Qualified Health Plan, we must allow the individual to enroll with the dependent(s) in another Qualified Health Plan within the same metal level or one metal level higher or lower if no such Qualified Health Plan is available. For the purpose of this provision, a “qualified individual” is an individual who has been determined eligible to enroll in a Qualified Health Plan through the Maryland Health Benefit Exchange. The Maryland Health Benefit Exchange will allow qualified individuals or Dependents to enroll in or change from one Qualified Health Plan to another as a result of the following triggering events: • Loss of minimum essential coverage. Loss of minimum essential coverage does not include loss due to: ▪ Failure to pay Premiums on a timely basis, including COBRA premium prior to the expiration of COBRA coverage, except for circumstances in which an employer completely ceases its contributions to COBRA continuation coverage or government subsidies of COBRA continuation coverage completely cease; ▪ Situations allowing for rescission of coverage (the individual performs an act, practice, or omission that constitutes fraud, or the individual makes an intentional misrepresentation of material fact); oror SAMPLE